Chronic Obstructive Pulmonary Disease

The diseases that fall under the scope of COPD are: Chronic Bronchitis, Emphysema and COPD-Asthma overlap. Chronic Bronchitis causes inflammation and irritation of the airways, the tubes in your lungs where air passes through. When the air tubes are inflamed and irritated, thick mucus begins to form in them. Over time, this mucus plugs up airways and makes breathing difficult. When you cough this mucus up, the excretions are known as sputum, or phlegm. Emphysema is a common type of COPD in which the air sacs of the lungs become damaged, causing them to enlarge and burst. Damage in this area makes it difficult for people with emphysema to expel air from their lungs. This leads to a build-up of carbon dioxide in the body and a myriad of emphysema signs and symptoms. Asthma COPD Overlap Syndrome (ACOS) is usually characterized by increased reversibility of airflow obstruction, eosinophilic bronchial and systemic inflammation, and increased response to inhaled corticosteroids, compared with COPD patients. The relevance of the ACOS is the need to identify patients with COPD who may have underlying eosinophilic inflammation that responds better to inhaled corticosteroids. Until new diagnostic tools are developed, a previous diagnosis of asthma in a patient with COPD can be a reliable criterion to suspect ACOS in a patient with COPD.

Chronic obstructive pulmonary disease (COPD) refers to a collection of lung diseases that can lead to blocked airways. People with COPD can be at risk for some serious complications that can not only put their health in jeopardy, but can also fatal. In COPD patients, Pneumonia occurs when bacteria enter the lungs, creating an infection. For COPD patients, pneumonia can weaken the lungs. This can lead to a chain reaction of illnesses that can weaken the lungs even further. This downward spiral can lead to a rapid deterioration of health in COPD patients. Respiratory Insufficiency is an important complication of chronic obstructive pulmonary disease. This may represent deterioration in the patient's premorbid condition such that hypoxemia worsens and hypercapnia develops during a relatively trivial respiratory tract infection, which may be viral or bacterial, Alternatively, these changes may occur for the first time in someone with less severe COPD who encounters a particularly dramatic cause for deterioration, e.g. lobar pneumonia or acute pulmonary oedema. Pneumothorax is defined as the accumulation of air or gas in the space between the lung and the chest wall. Also known as a collapsed lung, pneumothorax occurs when a hole develops in the lung that allows air to escape in the space around the lung, causing the lungs to partially or completely collapse. People with COPD, are at greater risk for pneumothorax because the structure of their lungs is weak and vulnerable to the spontaneous development of these types of holes. Pneumo mediastinum must be differentiated from spontaneous pneumothorax. Patients may or may not have symptoms, as this is typically a well-tolerated disease, although mortality in cases of esophageal rupture is very high.

The goal of COPD management is to improve a patient’s functional status and quality of life by preserving optimal lung function, improving symptoms, and preventing the recurrence of exacerbations. Currently, no treatments aside from lung transplantation have been shown to significantly improve lung function or decrease mortality; however, oxygen therapy (when appropriate) and smoking cessation may reduce mortality. Once the diagnosis of COPD is established, it is important to educate the patient about the disease and to encourage his or her active participation in therapy.

An acute exacerbation of COPD is a flare-up or episode when your breathing gets worse than usual and you become sick. It is most often linked to an infection. Exacerbations are often linked to a lung infection that results from a virus or bacteria, like a cold or some other illness. Spending time in smoggy or dirty air can also make your symptoms get worse quickly. Exacerbations Management may be accompanied by increased amount of cough and sputum productions, and a change in appearance of sputum. An abrupt worsening in COPD symptoms may cause rupture of the airways in the lungs, which in turn may cause a spontaneous pneumothorax. Preventing acute exacerbations Management helps to reduce long-term complications. Long-term oxygen therapy, regular monitoring of pulmonary function and referral for pulmonary rehabilitation are often indicated. Influenza and pneumococcal vaccines should be given. Patients who do not respond to standard therapies may benefit from surgery. Pulmonary Rehabilitations a programme of exercise and education for people with long-term lung conditions help to improve your muscle strength, so you can use the oxygen you breathe more efficiently, improve your general fitness and help you to cope better with feeling out of breath and also help you to feel to stronger and fitter, and able to do more PR is about helping you manage your condition better. It is not a cure, but you will feel better and more confident and in control. PR requires your commitment to really work. People who learn about their COPD and treatment plan are better able to recognize symptoms and take appropriate action. However, education is no substitute for regular exercise as part of a pulmonary rehab program.

Self- Management interventions help patients with chronic obstructive pulmonary disease (COPD) acquire and practise the skills they need to carry out disease-specific medical regimens, guide changes in health behaviour and provide emotional support to enable patients to control their disease. These programmes are based on the presumption that effective modification of behaviour can be attained only if patients’ self-efficacy has been improved. Patients who have enough confidence in their ability to successfully respond to certain events, such as at the time of an exacerbation, can more easily modify and maintain the desired behaviour. The behavioural modification should ultimately result in improved clinical outcomes. COPD self-management programmes have shown positive effects on patients’ quality of life and healthcare use in secondary care settings, but the benefits in general practice are still inconclusive. There are also  breathing techniques that can help you get the air you need without working so hard to breathe, Our primary objective was to assess the long term effects of two different modes of COPD disease management—comprehensive self-management and routine monitoring—on quality of life in COPD patients in general practice. As secondary objectives, we assessed the effects on frequency and patients’ management of exacerbations and on self-efficacy.

The symptoms of COPD cannot be completely eliminated with treatment and the condition usually worsens over time. However, treatment can control symptoms and can sometimes slow the progression of the disease. Medications that help open the airways, called bronchodilators, are a mainstay of treatment for chronic obstructive pulmonary disease. Bronchodilators help to keep airways open and possibly decrease secretions. Short-acting anticholinergic medication (ipratropium, Atrovent) improves lung function and symptoms. If symptoms are mild and infrequent, short-acting anticholinergic medication may be recommended only when you need it, and Long-acting beta agonists may be recommended if your symptoms are not adequately controlled with other treatments. Glucocorticoids taken in pill form or as an injection are sometimes used for short term treatment but are not generally used long-term because of the risk of side effects. Several such combinations are available including fluticasone proprionate/salmeterol (Advair) and budesonide/formoterol (Symbicort), which are taken twice daily, and fluticasone furoate/vilanterol (Breo), which is taken once daily. People with advanced COPD can have low oxygen levels in the blood. This condition, known as hypoxemia and the oxygen level can be measured with a device placed on the finger or with a blood test (arterial blood gas). Fatal fires have occurred in people attempting to smoke while using oxygen.  Unintended weight loss caused by shortness of breath usually occurs in people with more advanced lung disease. Not eating enough can lead to malnutrition, which can make symptoms worse and increase the likelihood of infection. Other treatments for COPD are including Noninvasive ventilatory support (the use of a special mask and breathing machine to improve symptoms), anti-anxiety or anti-depressant medications, or morphine-like medications to reduce shortness of breath.

Lung (pulmonary) function tests: Pulmonary function tests measure the amount of air inhaled and exhaled, and if your lungs are delivering enough oxygen to your blood.

Spirometry is the most common lung function test. Spirometer measures how much air lungs can hold and how fast air is blown out of your lungs. Spirometry can detect COPD even before symptoms of the disease arise. It can also be used to track the progression of disease and to monitor how well treatment is working. Spirometry often includes measurement of the effect of bronchodilator administration. Other lung function tests include measurement of lung volumes, diffusing capacity and pulse oximetry.

Chest X-ray: A chest X-ray can show emphysema, one of the main causes of COPD. An X-ray can also rule out other lung problems or heart failure.

CT scan: A CT scan of lungs can help detect emphysema and help determine the need for  surgery for COPD. CT scans can also be used to screen for lung cancer.

Arterial blood gas analysis: This blood test measures how well lungs are bringing oxygen into blood and removing carbon dioxide.

Laboratory tests: Laboratory tests aren't used to diagnose COPD, but they may be used to determine the cause of symptoms or rule out other conditions. For example, laboratory tests may be used to determine if you have the genetic disorder alpha-1-antitrypsin (AAt) deficiency, which may be the cause of some cases of COPD. 

The term lung disease refers to many disorders affecting the lungs, such as asthma, COPD, infections like influenza, pneumonia and tuberculosis, lung cancer, and many other breathing problems. Some lung diseases can lead to respiratory failure.

In recent years patients with respiratory diseases use various devices, which help the removal of mucus from the airways and the improvement of pulmonary function. These devices seem to increase patients' compliance to daily treatment, because they present many benefits, as independent application, full control of therapy and easy use. Some of the devices are -the Positive Expiratory Pressure, the High Frequency Chest Wall Oscillation, the Oral High Frequency Oscillation, the Intrapulmonary Percussive Ventilation, the Incentive Spirometry the Flutter and the Acapella and the Cornet. Current devices seem to be effective in terms of mucus expectoration and pulmonary function improvement.

Pediatric pulmonary study helps to provide comprehensive care to infants, children and adults with a full spectrum of respiratory disorders.comprehensive evaluation and treatment of children with acute and chronic respiratory diseases can be done with research in this field.